MEDICARE: DR. CHARLES DONALD BLODGETT D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	3292-012	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649371030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES DONALD BLODGETT D.C.

Provider Business Mailing Address
First Line	:	10025 W GREENFIELD AVE
Second Line	:
City	:	WEST ALLIS
State	:	WI
Zip	:	53214-3956
Country	:	US
Telephone Number	:	414-258-9511
Fax Number	:	414-607-3948

Provider Business Practice Location Address
First Line	:	10025 W GREENFIELD AVE
Second Line	:
City	:	WEST ALLIS
State	:	WI
Zip	:	53214-3956
Country	:	US
Telephone Number	:	414-292-3499
Fax Number	:	414-292-3494

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	02/15/2020

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